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Severe Sepsis and Septic Shock Review Article in NEJM by Drs. Derek Angus and T. van der Poll

Thu, 08/29/2013

As part of a series of review articles on critical care featured in the New England Journal of Medicine (NEJM), Drs. Derek C. Angus and Tom van der Poll’s publication, “Severe Sepsis and Septic Shock” started the series in this week’s edition of the NEJM.

Providing a comprehensive review of sepsis causes, pathophysiology and the search for new therapies, the researchers begin by explaining that sepsis is one of the oldest and most elusive syndromes in medicine. 

Sepsis, or severe sepsis, is a systemic inflammatory response to infection often complicated by acute organ dysfunction. Septic shock is yet another level of the syndrome where sepsis is complicated by either hypotension unmanageable with fluids or by hyperlactatemia, increased levels of lactic acid in the blood. 

The article reviews the causes of sepsis, occurring as a result of both community-acquired and health care-associated infections, with pneumonia being the most common cause.  Over 750,000 people in the United States suffer from sepsis each year.

As recently as 30 years ago, the death rate of those suffering from septic shock was 80%.  With advances in training, monitoring, and swift initiation of treatment to the underlying infection, the mortality is now closer to 20 – 30%.  Survivors of sepsis suffer from significantly accelerated physical and neurocognitive decline and so the focus of study is now on the recovery of sepsis survivors.

New strategies for treatment of sepsis are being developed, specifically precision-medicine strategies that include better pre-clinical models, more targeted drug development, and clinical trials incorporating better patient selection, drug delivery, and outcome measurements.  Newer and more innovative approaches to clinical trials are key to improving patient outcomes. 

Enjoy Drs. Angus and van der Poll’s full review article in this week’s edition of the NEJM.